Evaluation of solid portions in non-small cell lung cancer—the solid part is not always measurable for clinical T factor

Fukui, Manabu; Takamochi, Kazuya; Ouchi, Takehiro; Koike, Yutaro; Yaguchi, Takashi; Matsunaga, Takeshi; Hattori, Aritoshi; Suzuki, Kazutoshi; Hoshina, Ayako; Yamashiro, Y; Oh, Shiaki

doi:10.1093/jjco/hyaa181

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…In addition, in several studies, measuring the solid component size for atypical nodules was difficult, especially for GGO with scattered consolidations, with GGO mimicking organizing pneumonia. 28 , 29 In addition, the current guidelines for NSCLC treatment are based on the largest tumor diameter. More studies are warranted to construct a new system based on the eighth TNM staging.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, which CT window setting should be used for measuring the solid component is still under debate. In addition, in several studies, measuring the solid component size for atypical nodules was difficult, especially for GGO with scattered consolidations, with GGO mimicking organizing pneumonia 28,29 . In addition, the current guidelines for NSCLC treatment are based on the largest tumor diameter.…”

Section: Discussionmentioning

confidence: 99%

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Tumor size, but not consolidation‐to‐tumor ratio, is an independent prognostic factor for part‐solid clinical T1 non‐small cell lung cancer

et al. 2022

Thoracic Cancer

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Background Tumor size and consolidation‐to‐tumor ratio (CTR) are crucial for non–small cell lung cancer (NSCLC) prognosis. However, the optimal CTR cutoff remains unclear. Whether tumor size and CTR are independent prognostic factors for part‐solid NSCLC is under debate. Here, we aimed to evaluate the prognostic impacts of CTR and tumor size on NSCLC, especially on part‐solid NSCLC. Methods We reviewed 1366 clinical T1 NSCLC patients who underwent surgical treatment. Log‐rank test and Cox regression analyses were adopted for prognostic evaluation. The “surv_cutpoint” function was used to identify the optimal CTR and tumor size cutoff values. Results There were 416, 510, and 440 subjects with pure ground‐glass opacity (pGGO), part‐solid, and pure solid nodules. The 5‐year overall survival (disease‐free survival) for patients with pGGO, part‐solid, and pure solid nodules were 99.5% (99.5%), 97.3% (95.8%), and 90.4% (78.9%), respectively. Multivariate Cox regression analysis indicated that CTR was an independent prognostic factor for the whole patients, and the optimal CTR cutoff was 0.99. However, for part‐solid NSCLC, CTR was not independently associated with survival, even if categorized by the optimal cutoffs. The predicted optimal cutoffs of total tumor size and solid component size were 2.4 and 1.4 cm for part‐solid NSCLC. Total tumor size (HR = 6.21, 95% CI: 1.58–24.34, p = 0.009) and solid component size (HR = 2.27, 95% CI: 1.04–5.92, p = 0.045) grouped by the cutoffs were significantly associated with part‐solid NSCLC prognosis. Conclusions CTR was an independent prognostic factor for the whole NSCLC, but not for the part‐solid NSCLC. Tumor size was still meaningful for part‐solid NSCLC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tumor size, but not consolidation‐to‐tumor ratio, is an independent prognostic factor for part‐solid clinical T1 non‐small cell lung cancer

et al. 2022

Thoracic Cancer

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“…At first, inconsistency exists between radiological solid component size and pathological invasive size in part-solid lung adenocarcinomas, because the solid area often represents a benign scar or a fibrous scar harboring a stromal invasive component in part-solid tumors 25,26) . Furthermore, there are several findings of part-solid tumors in which the solid component size is quite difficult or impossible to measure due to the presence of multiple, complicated or scattered solid areas rather than a single focus 8,9,27) , which has not been absolutely determined in the new proposal. In the 8th edition of the T classification, there is no consensus Figure 2 Clinical T category was compared in the GGO and Solid groups, respectively.…”

Section: Proposal For Novel Clinical T Stagingmentioning

confidence: 99%

“…In contrast, new issues are emerging from the proposed changes concerning T parameters. Much of the confusion is caused by the absence of a consensus on how to make uniform the measurements of solid component size in many part-solid tumors in which solid component size is difficult or impossible to measure 8,9) . In such circumstances, we have reported a new and simple fact that the presence of a GGO denotes a great influence on the favorable prognosis of NSCLC, and the radiological solid component size is irrelevant to the survival outcome of NSCLC if the tumors show a GGO component [10][11][12][13][14][15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

Latest Clinical Evidence and Operative Strategy for Small-Sized Lung Cancers

Hattori

Suzuki

2022

Juntendo Medical Journal

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Many thoracic surgeons revealed that consolidation tumor ratio or solid component size on thin-section computed tomography has been considered more prognostic than maximum tumor size in non-small cell lung cancer (NCSLC). According to the results, the 8 th TNM classification drastically changed the staging system, i.e., clinical T category was determined based on the invasive or solid component size excluding a ground-glass opacity (GGO). However, several debates are arising over the application of radiological solid size for the clinical T staging. Meanwhile, recent several institutional reports have noticed a significantly simple fact that the presence of a GGO denotes an influence on the favorable prognosis of NSCLC. More important, radiologic pure-solid lung cancers without a GGO exhibit more malignant behaviors with regard to both the clinical and pathological aspects, and show several histologic types that have a poorer prognosis than radiologic part-solid lung cancer. In contrast, favorable prognostic impact of the presence of a GGO component was demonstrated, which was irrespective of the solid component size in cases in which the tumor showed a GGO component. Recently, this concept has been gradually noticed on a nationwide level.Obvious distinctions regarding the several baseline characteristics between the tumor with/without GGO component is a fundamental biological feature of early-stage lung cancer, which would result in a big difference in prognosis, modes of recurrence, overall behavior, and appropriate operative strategies. As a future perspective, the presence or absence of a GGO should be considered as an important parameter in the next clinical T classification.

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“…However, not all solid components are typical and easily measured. Studies of part-solid nodules (PSNs) with difficult-to-measure solid components demonstrate that such PSNs are less invasive and rarely have lymphatic invasion ( 14 – 16 ). This suggests that different distributions of solid and other components have prognostic implications.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Prognosis in Patients with Lung Adenocarcinoma with Atypical Solid Nodules on Thin-Section CT Images

Liu,

Yang,

Sun

et al. 2024

Radiology: Cardiothoracic Imaging

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Purpose To evaluate the clinicopathologic characteristics and prognosis of patients with clinical stage IA lung adenocarcinoma with atypical solid nodules (ASNs) on thin-section CT images. Materials and Methods Data from patients with clinical stage IA lung adenocarcinoma who underwent resection between January 2005 and December 2012 were retrospectively reviewed. According to their manifestations on thin-section CT images, nodules were classified as ASNs, subsolid nodules (SSNs), and typical solid nodules (TSNs). The clinicopathologic characteristics of the ASNs were investigated, and the differences across the three groups were analyzed. The Kaplan-Meier method and multivariable Cox analysis were used to evaluate survival differences among patients with ASNs, SSNs, and TSNs. Results Of the 254 patients (median age, 58 years [IQR, 53–66]; 152 women) evaluated, 49 had ASNs, 123 had SSNs, and 82 had TSNs. Compared with patients with SSNs, those with ASNs were more likely to have nonsmall adenocarcinoma ( P < .001), advanced-stage adenocarcinoma ( P = .004), nonlepidic growth adenocarcinoma ( P < .001), and middle- or low-grade differentiation tumors ( P < .001). Compared with patients with TSNs, those with ASNs were more likely to have no lymph node involvement ( P = .009) and epidermal growth factor receptor mutation positivity ( P = .018). Average disease-free survival in patients with ASNs was significantly longer than that in patients with TSNs ( P < .001) but was not distinguishable from that in patients with SSNs ( P = .051). Conclusion ASNs were associated with better clinical outcomes than TSNs in patients with clinical stage IA lung adenocarcinoma. Keywords: Adenocarcinoma, Atypical Solid Nodules, CT, Disease-free Survival, Lung, Prognosis, Pulmonary Supplemental material is available for this article . Published under a CC BY 4.0 license.

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Evaluation of solid portions in non-small cell lung cancer—the solid part is not always measurable for clinical T factor

Cited by 4 publications

References 15 publications

Tumor size, but not consolidation‐to‐tumor ratio, is an independent prognostic factor for part‐solid clinical T1 non‐small cell lung cancer

Tumor size, but not consolidation‐to‐tumor ratio, is an independent prognostic factor for part‐solid clinical T1 non‐small cell lung cancer

Latest Clinical Evidence and Operative Strategy for Small-Sized Lung Cancers

Evaluation of Prognosis in Patients with Lung Adenocarcinoma with Atypical Solid Nodules on Thin-Section CT Images

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